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[Resection of the trachea and bifurcation in newborn infants and children]
P Schneider1, H D Becker, T Muley
1Abteilung für Allgemein-, Gefäss- und Thoraxchirurgie, Klinikum Benjamin Franklin, Freie Universität Berlin.
Insights
Tracheal resection in children effectively treats acquired and congenital stenosis, with high decannulation rates and low morbidity. Single-session procedures, especially with interdisciplinary cooperation, are safe and successful.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Context:
- Tracheal stenosis in children presents significant challenges.
- Surgical intervention is often necessary for acquired and congenital cases.
- Previous management strategies had varying success rates and morbidity.
Purpose:
- To evaluate the safety and efficacy of tracheal and/or bifurcation resections in pediatric patients.
- To assess outcomes based on stenosis location (upper/middle vs. distal) and type.
- To determine the impact of single-session resection with interdisciplinary cooperation.
Summary:
- 38 tracheal/bifurcation resections were performed in 37 children (1 month-18 years) between 1973-1994.
- Acquired stenosis was most common (24 cases), followed by congenital (8) and combined (5).
- Upper/middle tracheal resections (22 children) showed 96% decannulation with 0% morbidity; distal resections (15 children) had 87% decannulation with 6% morbidity.
Impact:
- Single-session tracheal resection is a safe and effective procedure for pediatric stenosis.
- High decannulation rates and low morbidity underscore the success of surgical intervention.
- Interdisciplinary cooperation is crucial for optimizing outcomes in complex pediatric airway reconstruction.
Abstract:
From 1973 to 1994, 38 tracheal and/or bifurcation resections were performed in 37 children aged 1 month to 18 years. Twenty-four children had an acquired stenosis, 8 a congenital and 5 a combined stenosis. In 16 children, the stenosis was located in the lower trachea or bifurcation. Other malformations were found in 12 children. The most common intervention was the trachea segment resection in 30 patients; resection of the cricoid cartilage was performed in another 6 cases. The resection was expanded to the bifurcation 5 times, 1 being a left sleeve pneumonectomy. The extent of resection was between 10 and 50 mm. In the 22 children with resections of the upper and middle trachea, 96% were decannulated with 0% morbidity. In the 15 children with distal resections, decannulation was performed in 87% with 6% morbidity. There were no recurrent stenoses caused by growth disorder. With interdisciplinary cooperation, single-session resection is a safe procedure.